Connecticut Administrative Code
Title 17 - Public Assistance and Welfare Services
83k - Administrative Sanctions to be Invoked Against Vendors and/or Providers of Goods and Services Under the Title XIX (Medicaid) Program
Section 17-83k-6 - Termination upon conviction

Universal Citation: CT Reg of State Agencies 17-83k-6

Current through September 9, 2024

(a) Notwithstanding any other provisions of these regulations to the contrary, any vendor against whom a judgment of conviction has been rendered in any state or federal court of a crime involving fraud in said programs shall be terminated from participation. Termination shall be effective upon conviction, except that the Commissioner may delay termination for a period he deems sufficient to protect the health and well-being of beneficiaries receiving goods and/or services from such vendor. No vendor or person so terminated or denied reimbursement shall be readmitted to or be eligible for reimbursement in such programs for at least one year from the date of termination or conviction.

(b) The Commissioner shall notify said vendor of such termination by certified mail, return receipt requested. The notification shall inform the vendor of his/her ineligibility for reimbursement for any goods provided or services performed directly by, or under the supervision of, said vendor for the period of termination, and of the right to a hearing, provided the request is filed with the Commissioner in writing within ten (10) days of the notice date.

(c) The scope of the hearing shall be limited to (1) whether the vendor was convicted, (2) whether the conviction is related to the vendor's participation in programs conducted by the Department of Income Maintenance, (3) whether the amount of restitution sought by the Department is accurate, and (4) the appropriateness of the period of termination.

(d) In setting the termination period, the Department will consider:

(1) The number and nature of the program violations and other related offenses;

(2) The nature and extent of any adverse impact the violations have had on beneficiaries;

(3) The amount of damages incurred by Medicaid, or other social service programs for which the Department is responsible;

(4) Whether there are any mitigating circumstances;

(5) The length of the sentence imposed by the court;

(6) Any other facts bearing on the nature and seriousness of the program violations, and

(7) The previous sanction record of the terminated party.

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